A Living Will is a written set of directions regarding your health care, to be followed in case you are unable to make or communicate health care decisions. The document becomes effective only if you are physically or mentally unable to give directions on your own medical care and only if you are terminally ill or permanently unconscious.

A Kentucky Living Will allows you to leave directions in four critical areas.

You can:

Name someone to make health care decisions for you when you are unable to make health care decisions for yourself.

Leave directions regarding life-prolonging treatment.

Leave directions regarding the use of artificially provided food and water.

Leave directions regarding your beliefs relevant to the use of your body for medical research or organ donation.

You have a basic right to make your personal health care decisions. The best way to protect this right is to name someone you trust to make health care decisions for you in the event you are unable to and leave a set of directions to guide that person in making your health care decisions. A living will is the easiest way to do this.

The burden of making your health care decisions falls to others at times of serious illness. A living will provides guidance for the health care decision makers, making the process less stressful. A living will also increases the likelihood that the health care that you receive, is the health care that you would have chosen for yourself.

No. However, if you do not have one and you become terminally ill and unable to make your own decisions, the medical staff and/or your family may decide to have medical procedures done to you that you do not want. A living will can make your wishes known if you do not want such procedures to be done to you.

When a patient has not chosen a health care surrogate and they can't tell health care providers what care they want to receive, the health care providers are required by law to ask relatives specified in that law. The person or persons specified in the law may not be the person that you most trust to make these decisions. With a living will, you name your first choice and back-up choices to make health care decisions for you. In a living will you can authorize someone other than a family member to make health care decisions for you.

You can fill in this form or write your own or you may wish to have an attorney do one for you. If you need help you can call The Legal HelpLine for Older Kentuckians at 1-800-200-3633 or contact your local Kentucky legal services office.

In order to do a living will, you must:

Be 18 years of age or older;

Be competent;

Voluntarily want to do the living will; and

Sign in the presence of two witnesses OR a notary public. (If you are unable to sign yourself, you can direct someone to sign for you while you watch).

If you choose to complete the form requiring the signature of two witnesses, then the form should be signed by you in their presence.

No. The following persons may not be a witness: a blood relative, a beneficiary under the Kentucky laws of descent and distribution, an employee of a health care facility in which you are a patient (unless the employee serves as a notary public), your attending physician, or any person financially responsible for your health care.

You need to make sure your doctors have a copy of the living will so that it can be made a part of your medical records. You should also keep a copy of the living will with your important papers. You should give a copy and discuss your living will with your appointed health care surrogate (if you decide to appoint a health care surrogate). You may also want to discuss your living will and your wishes concerning medical treatment with all your family members.

The living will becomes effective only if you become terminally ill or permanently unconscious. Your doctor must first determine if you are unable to make your own health care decisions. Then your doctor and one other physician must determine that you are in a terminal condition or a permanently unconscious state. The living will does not apply to all health care decisions; it applies only to medical procedures/treatments that use artificial means to carry out your body’s vital functions or that prolong the dying process. For example, a living will would apply to the medical decision to place you on a ventilator or put a tube in you for feeding. The living will does not apply to medical care to provide comfort or stop pain; so even if you have a living will you could still receive medical care to help you with pain and to make you more comfortable.

What if I do want extraordinary life support measures even if I am terminally ill or permanently unconscious?

The Living Will form in Kentucky allows you to choose. You can state that you do not authorize that life-prolonging treatment or artificially provided nourishment or fluids be withheld or withdrawn. In other words, you want extraordinary life support measures. You may also appoint a friend or family member as your health care surrogate and ask that she or he make the treatment choices. Again, this document becomes effective only if you are physically or mentally unable to give directions on your own medical care.

My wishes regarding life-prolonging treatment and artificially provided nutrition and hydration to be provided to me if I no longer have decisional capacity, have a terminal condition, or become permanently unconscious have been indicated by checking and initialing the appropriate lines below. By checking and initialing the appropriate lines, I specifically:

___ Designate __________ as my health care surrogate to make health care decisions for me in accordance with this directive when I no longer have decisional capacity. If __________ refuses or is not able to act for me, I designate __________ as my health care surrogate.

Any prior designation is revoked.

If I do not designate a surrogate, the following are my directions to my attending physician. If I have designated a surrogate, my surrogate shall comply with my wishes as indicated below:

___ Direct that treatment be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance of any medical treatment deemed necessary to alleviate pain.

___ DO NOT authorize that life-prolonging treatment be withheld or withdrawn.

___ Authorize the withholding or withdrawal or artificially provided food, water, or other artificially provided nourishment or fluids.

___ DO NOT authorize the withholding or withdrawal of artificially provided food, water, or other artificially provided nourishment or fluids.

___ Authorize my surrogate, designated above, to withhold or withdraw artificially provided nourishment or fluids, or other treatment if the surrogate determines that withholding or withdrawing is in my best interest, but I do not mandate that withholding or withdrawing.

___ Authorize the giving of all or any part of my body upon death for any purpose specified in KRS 311.185.

___ DO NOT authorize the giving of all or any part of my body upon death.

In the absence of my ability to give directions regarding the use of life-prolonging treatment and artificially provided nutrition and hydration, it is my intention that this directive shall be honored by my attending physician, my family, and any surrogate designated pursuant to this directive as the final expression of my legal rights to refuse medical or surgical treatment and I accept the consequences of the refusal.

I understand the full import of this directive and I am emotionally and mentally competent to make this directive.

Signed this ___ day of __________, 200__.

____________________
GRANTOR

STATE OF KENTUCKY
COUNTY OF __________

Subscribed to and sworn before me by this the ___ day of __________, 200__.
My commission expires: __________

____________________
NOTARY PUBLIC
KENTUCKY, STATE AT LARGE

Execution of this document restricts withholding and withdrawing of some medical procedures, Consult Kentucky Revised Statutes or your attorney.